What is covered?

In Australia, Medicare provides universal health insurance that delivers affordable, accessible and high-quality health care for citizens and permanent residents. However you can also choose to take out private health insurance to give you more health care options and to cover items which aren't covered on Medicare.

Medical Services and General Treatment

Private Cover

Medicare

If you visit a doctor outside a hospital, Medicare will reimburse 100% of the MBS fee for a general practitioner and 85% of the MBS fee for a specialist - this applies whether or not you hold private health insurance. If your doctor bills Medicare directly (bulk billing), you will not have to pay anything.

Pharmaceutical

Private Cover

Medicare

Under the Pharmaceutical Benefits Scheme (PBS), you pay only part of the cost of most prescription medicines purchased at pharmacies - this applies whether or not you hold private health insurance. The rest of the cost is covered by the PBS. You must present your Medicare card to obtain this benefit.

The amount you pay varies with the medicine, up to a standard maximum. People with concession cards have a lower maximum payment.

You can arrange private health insurance to cover many prescription medicines which aren't listed on the PBS. Most funds will require you to make a co-payment towards the cost and will have limits on how much you can claim.

Some prescription medicines are not listed on the PBS. You pay the full amount for these non-PBS items.

Ambulance

Private Cover

Medicare

In Queensland and Tasmania, emergency ambulance services are provided free by the State Government. New South Wales and Australian Capital Territory provide free ambulance cover for pensioners and low income earners.

If you do not fall into any category above you can arrange ambulance cover from the ambulance authority in your state or with a health fund.

Medicare does not cover the cost of emergency or other ambulance services.